220 likes | 421 Views
The Arguments Against. Dr. Anthony G. Crocco. Why listen to me?. Deputy Chief - McMaster Children’s Hospital ER Pediatric Consultant - BEEM Tutor - EBCP Course Member - PERC International Educator No industry sponsorship. The Argument Against. Research problems :
E N D
The Arguments Against • Dr. Anthony G. Crocco
Why listen to me? • Deputy Chief - McMaster Children’s Hospital ER • Pediatric Consultant - BEEM • Tutor - EBCP Course • Member - PERC • International Educator • No industry sponsorship
The Argument Against • Research problems: • How the evidence was presented • Risk of the unknown • A researcher’s story • The true value of this paper
Plint - 2009 • “Among infants with bronchiolitis treated in the emergency department, combined therapy with dexamethasone and epinephrine may significantly reduce hospital admissions.”
Plint - 2009 • “Among infants with bronchiolitis treated in the emergency department, combined therapy with dexamethasone and epinephrine may (NOT) significantly reduce hospital admissions.”
Plint - 2009 • “our results should be considered exploratory” • “confirmation of our findings by a study powered specifically to compare combined epinephrine and dexamethasone therapy with placebo is needed”
Steroids safe? • False belief that systemic steroids in premature infants was safe • Developmental delay (Barrington 2001)
Steroids safe? • False belief that inhaled steroids had no effect on long-term height • 1.2cm difference (Kelly 2012)
A Researcher’s Story... • What would you do if...?
The True Value • Exciting and unexpected synergy between epinephrine and steroid use • Clinically confirms evolving understanding of cellular receptors • Future work needs to be done to find the lowest, shortest and safest dosing
Conclusions • Results that may benefit, may not benefit! • No confidence lines? No confident results! • First do no harm! Beware of myopia! • The researchers are not suggesting routine use and would not use it on their own family!
The Arguments Against • Dr. Anthony G. Crocco